Texas ban on gender-affirming care leaves trans teens without options

From her now near-empty home in the Dallas suburb of Plano, with moving boxes stacked high in the garage, pediatric endocrinologist Ximena Lopez says she never thought she'd see this day.

Fearing violence that could target her family a response by some to the type of medical treatment she offers Lopez is closing her health clinic, selling her houseand fleeing Texas for California.

"I don't feel safe," she said. "With so many people with guns [who] have gone to protest against me, or our clinic ... armed."

She adds, "I'm afraid of leaving my son home alone, and I don't want to live like that."

For years, Lopez has operated a clinic at a Dallas medical centre that offers what's known as gender-affirming care for young people. It's aimed at aiding and comforting transgender teens.

Treatment includes recurrent counselling and controversially medication that temporarily blocks puberty.

In America, it's an extremely divisive program.

Nearly two dozen U.S. states, mostly Republican-led, have now taken steps to ban the treatment. (Some of those bans have been successfully challenged in court. Civil rights advocates pledge more challenges will follow.)

Separately, various state legislatures have put forward roughly 500 bills this year alone deemed by the American Civil Liberties Union as being anti-LGBTQ, including restrictions on bathroom use, pronouns, drag performances and education.

Civil libertarians describe it as a growing wave of intolerance in the U.S. targeting that communityand medical providers such as Lopez.

Texas passed its bill banning gender-affirming care for teens this spring after a raucous debate, with vocal protests by the program's supporters.

The new law takes effect in September.

Lopez and others underline that the treatment is decisively evidence-based, and she believes in it deeply. She calls it "one of the most important things I've done in my life."

But opponents have called her a child abuser and a Nazi. Some have said she "should die in hell," leaving Lopez frightened, frustrated and angry.

"The whole state has become crazy," said Lopez. It "is right now full of hate."

"I felt like things were evolving with society, with progress. Now we are going backwards," she said.

"It has become unbearable."

Patients caught in the crosshairs

Chief among those caught in the crosshairs are the patients of Lopez. When she moves to California, where her treatment remains legal, her patients in Texas will face dwindling access to medications and no easy path for direct care.

Most of those contacted directly by CBC News said they strongly support Lopez and her work but were afraid to speak out publicly, worried about stigma and violence that could target them.

But on agreement to withhold their surname to reduce the risk, parents Kristen and Wes and daughter Audrey sat down with CBC News at their home northeast of Dallas to talk about all of it. They strongly wanted others to know what Audrey has gained from her time with Lopez and what the new law in Texas now threatens.

In short, they believe Lopez and her program saved Audrey's life.

Audrey, who's 14, is the transgender daughter of Kristen and Wes.

"I don't think there's any other word to describe myself other than a girl," Audrey said.

For years Audrey had been bullied at school, left feeling afraid, in deep depression and contemplating self-harm. As Audrey puts it, none of her friends believed what she had always expressed: that from her earliest memory she knew she was a girl, on the inside.

Lopez describes that knowing, among her patients, as being consistent, persistent, insistent. Audrey was always all three.

At first her parents, both Christian conservatives, believed otherwise.They were perplexed that she shirked boys' clothes and had no interest in boys' toys.

They believed she was a boy. "First-born son," Wessaid. But Audrey knew the opposite.

"She was so depressed," Kristen said. "It was getting to the point where she was going to hurt herself."

So her parents met with a counsellor who told them that Audrey, then 9, was suicidal. The family then sought out Lopez.

"The first time I met Dr. Lopez," Audrey said, "I [believed] everything was going to change.

"I was thinking how nobody would ever say anything to me again. They would finally ... accept me."

WATCH | Transgender teens including Audreyare losing health care due to Texas ban:

Caught in the crosshairs of Texas ban on transgender health care for kids

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Texas is now the largest U.S. state to ban gender-affirming care, including puberty blockers and hormone therapy for minors. As the new law comes into effect, CBCs Paul Hunter finds doctors, families and patients who are afraid of what comes next.

Her parents quickly came around and today are fully supportive and grateful.

Wes emphasizes that as soon as Audrey sat down with Lopez, her emotional well-being turned around immediately.

"I can tell you," Wes said, "it was a different kid. Night and day."

He says Lopez's program "gave us so much hope to get her [to] that next stage in life. I don't think, without it, we would get there."

Kristen agrees.

"I don't think she would be [alive] if we hadn't done something."

With the new law in Texas set to kick in Sept. 1, Audrey and her family worry about the future. Eventually her puberty-blocking meds will run out, and her doctor will then be in another state.

Without the medication, puberty will resume. They don't know what they'll do.

"It's absolutely devastating," Kristen said, glancing at her daughter. "She's happy. We're doing good.

"And now the state is going to take that away."

'I do not regret my transition'

One of the questions about the program raised by critics concerns its long-term impact.

On that, Evan Singleton of Denton, Texas, is eager to wade in.

He was the very first patient of Lopez, as a young trans boy, back when she opened her clinic in 2015.

Now he's a bearded and broad-shouldered 21-year-old, no longer in the care of Lopez, having outgrown it.

"I identify as a trans man," he said. "I'm doing good. My gender is kind of exactly where I like it to be."

Singleton says gender-affirming care allowed him to be him. Lopez, he says, turned his life around.

"Grateful is the first word that comes to mind," he said of her.

His view of the politics of transgender issues in Texas is blunt.

"I think Texas is so scared," Singleton said.

"They want to protect children, [but] they're not listening to the science that protects children," he said.

"I'm an adult and I do not regret my transition, and I am scared at what could have happened without it."

Evidence of benefits

But the views of Lopez and her patients are not unanimous.

Critics will point to examples of people (not connected to Lopez) who transitioned but later regretted it. Lopez underlines that such incidents are outweighed by the wealth of research demonstrating the benefits of her work.

She points to studies that show puberty suppression treatment among transgender youth sharply reduces the rate of depression and suicide and, more broadly, that the treatment leads to happier adult lives.

And, she says, given the emotional distress faced by so many young people going through this, what is the alternative?

Lopez compares the changing American landscape for gender-affirming care with that of access to abortion, in that access is not equal and depends on where someone lives.

She now labels Texas a "dictatorship,"fuelled more by attitudes and politics than science.

"They don't care about these kids," she said.

"I mean, what kind of people do we have in power? Are they supposed to be there to protect the most vulnerable? Because these [trans] kids amongst all the kids are the most vulnerable.

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'It makes me livid'

For her part, Audrey worries about what will happen come the time her meds run out.

She is determined to be optimistic and finds tremendous support not only from her parents but from a circle of friends who now support her.

But she's frustrated and angry that the treatment thathas changed her life is being forcibly ended by her own state.

"Hopefully something changes," she said. "It makes me livid."

Not long ago, Audrey gathered the courage to go up on stage in front of a small crowd near her home, stand in front of a microphone and say the following:

"If you really don't like this, I don't care.

"I am trans," she continued. "I am a trans female. I was born male and I identify as female now."

The crowd broke into applause.